Provider Demographics
NPI:1396868287
Name:JOSEPHS, ELYSE IRIS (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:IRIS
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20762
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0075
Mailing Address - Country:US
Mailing Address - Phone:917-374-6046
Mailing Address - Fax:212-734-9240
Practice Address - Street 1:34 W 12TH ST
Practice Address - Street 2:TWELTH MERIDIAN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8636
Practice Address - Country:US
Practice Address - Phone:917-374-6046
Practice Address - Fax:212-734-9240
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002232171100000X
CT000383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45-0546827OtherEIN#